Housemate Application RM_StatsYour InformationName *Address Address Line 1 * Address Line 2 City * State or Region State or Region * United States Canada Zip * Email *Home PhoneCell PhoneWork PhoneBest number to call during the dayHomeCellWorkThere are typically 4 times as many people looking for housing as there are homes available. We cannot guarantee that everyone will find housing through our program.What is the maximum rent per month you would pay?What pets do you have?If you own a dog, has it ever bitten anyone?YesNoCurrent Housing SituationIf other, please explainRentOwnOtherExplanation of current housing situationHow long at current address?FromToIf renting, current landlord's name and numberWe ask for the following information to help determine that RappHomeShares does not discriminate in its services.GenderDate of BirthAgeDo you have a disability?YesNoDo you receive Medicaid?YesNoAnnual income (must include all sources of income)ReferencesAll references should be people who have known you at least 1 year. Together, the references should cover a span of at least 5 years to the present. We require references from past or present roommates, employers, or co-workers. NOT ACCEPTED as references are family members, friends, or romantic partners. Tell your references that RappHomeShares will be calling them. If you have trouble reaching them, we will have the same trouble, and your application will be delayed.Reference 1Daytime phoneCityStateEmailHow long have they known you?How do they know you?Reference 2Daytime phoneCityStateEmailHow long have they known you?How do they know you?Other information you want us to knowIs there another adult seeking housing with you?YesNoAcknowledgment *I hereby acknowledge that all the information I have given in this application is true and complete to the best of my knowledge and belief. I understand that providing any false or misleading information will make me ineligible for the services of RappHomeShares.I agreeSigned * Note: It looks like JavaScript is disabled in your browser. Some elements of this form may require JavaScript to work properly. If you have trouble submitting the form, try enabling JavaScript momentarily and resubmit. JavaScript settings are usually found in Browser Settings or Browser Developer menu.
